Functional Popliteal Artery Entrapment Syndrome: A Review of the Anatomy and Pathophysiology

Abstract

Objectives: This paper reviews the knowledge regarding the embryogenesis and anatomy of the popliteal fossa with the aim of determining which variations predispose towards exertional leg pain and Functional Popliteal Artery Entrapment Syndrome (PAES) in particular. Methods: Current literature review and synopsis of published knowledge is presented. Ethics approval was granted for this study by the Greenslopes Research and Ethics Committee. Results: Functional PAES is thought to be more common than previously recognized. Four subgroups of clinical presentation were found, depending on anatomical variation in the popliteal fossa: Anatomical PAES; Functional PAES; Asymptomatic Occluders and Asymptomatic Non-occluders. Features predisposing towards Functional PAES include a more lateralized medial head of gastrocnemius and a lower percentage of maximal force of plantarflexion required to cause occlusion of the artery. Conclusions: Functional PAES may be responsible for a large number of previously unrecognized cases of exertional leg pain, and an understanding of how it develops is important. In understanding the anatomical variations present in the popliteal fossa, one can classify which sub-group the patient belongs to, and how much this predisposes towards the development of exertional leg pain. The necessity for treatment, as well as where interventions should be targeted, can be determined by coupling these investigation findings with clinical features of claudicant leg pain.